Nitroglycerin is a vasodilator. Nitroglycerine is a smooth muscle relaxant that acts on vascular, bronchial, uterine, and intestinal smooth muscle. It dilates, or expands the passageway, of arterioles and veins in the periphery, reduces the preload and afterload of the heart. This decreases the work load that the heart is under which also reduces the myocardial oxygen demand.
Indications and Contrindications
Nitroglycerin is indicated for patients with acute angina pectoris, ischemic chest pain, hypertension, cardiac heart failure and pulmonary edema. It should not be used for patients with hypotension, hypovolemia, intracranial bleeding, head injuries, previous administration of Viagra, Revatio, Levitra, Cialis, or other similar agents within the last 24 to 36 hours.
Nitroglycerin Side Effects
Headache, hypotension, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, and muscle twitching are possible adverse reactions to nitroglycerin. The active ingredient may also cause a stinging sensation when administered. Make sure that you let your patient know this ahead of time so they do not freak out. Let them know that it is normal.
This medication has additive effects if used in combination with any other vasodilators and is incompatible with other drugs intravenously. Nitroglycerin is a class C drug, and should be very closely monitored if needed for a pregnant patient. Geriatric patients are also more likely to experience hypotension after vasodilator administration.
Nitroglycerin tablets come in different strengths; 0.15 mg (1/400 grain), 0.3 mg (1/200 grain), 0.4 mg (1/150 grain), and 0.6 mg (1/100 grain). Nitroglycerin spray comes in 0.4 to 0.8 mg per spray. There is also a nitroglycerin IV available called Nitrostat. The tablets and spray are placed under the tongue (SL) for rapid absorption.
Dosage and Administration
Tablets should be given in 0.3 to 0.4 mg doses and can be repeated in 3 to 5 minutes for a maximum of 3 doses. Nitroglycerin spray should be given in 0.4 mg doses under the tongue, 1 to 2 sprays. If giving Tridil via IV infusion, begin at 10 to 20 ug/min and gradually increase by 5 to 10 ug/min every 5 minutes until you see the desired effect.
Typical onset for nitroglycerin is quick at 1 to 3 minutes. It's peak effect can be seen after 5 to 10 minutes will last for 20 to 30 minutes for the tablet and spray. In the case of IV administration, the duration of action will last 1 to 10 minutes after the infusion is discontinued.
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